Association Between Adipokine Profile, Systemic Inflammation, Muscle and Protein Energy Wasting in Children With Chronic Kidney Disease

Abstract

This cross-sectional study explores the association of adipokines and interleukin-6 (IL-6) with muscle and protein energy wasting (PEW) in children with chronic kidney disease (CKD). We measured serum adiponectin, leptin, resistin and IL-6 in 53 patients with CKD stage 3-5. Lean tissue (LTI) and fat tissue index (FTI) were estimated by bioimpedance analysis spectroscopy. PEW was defined as muscle wasting [LTI adjusted to height age (LTI HA) z-score <-1.65 SD) and at least two of the following: reduced body mass [body mass index adjusted to height age (BMI HA) z-score <-1.65 SD), poor growth [height z-score <-1.88 SD], questionnaire based decreased appetite, serum albumin ≤ 3.8 g/dl. PEW, observed in 8 (15.1%) patients, was more prevalent in CKD stage 5 (p=0.010). Among the adipokines, adiponectin and resistin levels were significantly higher in CKD stage 5 (p<0.001, p=0.005). Adiponectin was correlated to LTI HA z-score (Rs=-0.417, p=0.002), leptin to FTI z-score (Rs=0.620, p<0.001), while no correlation was observed between resistin and body composition parameters. Resistin was the only adipokine correlated to IL-6 (Rs=0.513, p<0.001). After adjustment for CKD stage and patient age, PEW was associated with adiponectin and IL-6 rise by 1 μg/ml and 10 pg/ml respectively (OR 1.240, 95% CI 1.040, 1.478 and OR 1.405, 95% CI 1.075-1.836) but not with leptin, while resistin association with PEW lost its significance. In pediatric CKD, adiponectin is associated with muscle wasting, leptin with adiposity and resistin with systemic inflammation. Adiponectin and cytokine IL-6 may serve as PEW biomarkers.